- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.34 / $134.81 / $208.18
| Professional | | $103.34 | $134.81 | $208.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.64 / $145.08 / $214.28
| Professional | | $118.64 | $145.08 | $214.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.77 / $210.89 / $298.35
| Professional | | $140.77 | $210.89 | $298.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.50 / $181.78 / $322.64
| Professional | | $138.50 | $181.78 | $322.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.76 / $144.80 / $235.02
| Professional | | $105.76 | $144.80 | $235.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.47 / $195.78 / $295.80
| Professional | | $138.47 | $195.78 | $295.80 |